Controls for flow cytometry analysis of blood cells included samples from non-vaccinated blood bank donors ( n = 11) and vaccinated healthcare workers ( n = 8). 3 Blood samples from health careworkers of both sexes, in the same age group as the patients, were used as controls for plasma studies (unvaccinated n = 11, ChAdOx1 nCov-19 vaccinated n = 8). Clinical data are summarized in Supplementary material online, Table S1 and have previously been described. Four of the patients had major cerebral haemorrhage and three of the patients died. They were admitted to Oslo University Hospital with thrombosis and thrombocytopenia 7–10 days after vaccination with ChAdOx1 nCoV-19. In brief, the patients were five healthcare workers from 32 to 54 years old: one man and four women. This includes the composition of sinus venous thrombi retrieved from one of the patients with fatal outcome. Here, we describe immune complexes (ICs) that incorporated multiple triggers of innate immunity, and inflammatory and thrombogenic profiles in five VITT patients admitted to Oslo University Hospital. However, the molecular triggers are not fully elucidated, and detailed examination of the thrombus has been lacking. 6 All these studies have identified a pathogenic anti-PF4/polyanion-dependent syndrome, unrelated to the use of heparin therapy. Based on reported cases of VITT from nine countries with moderate-to-high data quality, the estimated risk of developing VITT after the first dose of ChAdOx1 nCoV-19 ranges from 1 case per 26 500 to 1 case per 148 200. 5 reported 23 similar cases with severe thrombotic episodes 6–24 days following ChAdOx1 nCoV-19 vaccination. Three of the five patients died, of what has been termed as vaccine-induced immune thrombotic thrombocytopenia (VITT) in two previous reports. 2 Within 10 days after vaccination with ChAdOx1 nCov-19, five healthcare workers from 32 to 54 years of age were admitted to Oslo University Hospital with severe cases of thrombosis, thrombocytopenia, remarkably high titres of anti-platelet factor (PF)4/polyanion IgG, and atypical, hyperactive platelet aggregation assays. On March 11, after 132 686 individuals in Norway had received the first dose of the ChAdOx1 nCoV-19 adenoviral vector vaccine against COVID-19, 1 this vaccination was stopped following reports from Denmark of a possible connection between the vaccine and fatal cases of thrombosis. See page 4073 for the editorial comment for this article ‘Thromboinflammatory findings and clinical predictors of mortality in vaccine-induced immune thrombotic thrombocytopenia’, by J.M. Vaccine-induced immune thrombotic thrombocytopenia, Thrombus, Immune activation, Neutrophils
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